Pygeum (Pygeum africanum), also known as African plum (a related plant, African Cherry or Prunus africana is also used as pygeum to treat BPH), is a large evergreen tree that grows in the high plateaus of Southern Africa. The pygeum bark is traditionally powdered and drunk as a tea for genito-urinary complaints such as bladder pain and urinary difficulty. As with saw palmetto, pygeum has predominantly been used and tested throughout Europe for the treatment of Benign Prostatic Hyperplasia (BPH) and its most common symptoms including effectiveness in decreasing frequency of nocturnal urination, increasing urine volume, decreasing incidence of incomplete bladder emptying, and reducing prostate enlargement. In France and Italy, pygeum is the main course of natural treatment for BPH and is usually used in combination products that contain other herbal BPH treatments such as saw palmetto (the most popular in Germany) and nettle root. Increased demand for pygeum has led to over-harvesting and is threatening the survival of the species, with international trade currently being monitored.
Although the mechanism of action of pygeum is largely unknown, it is theorized to inhibit fibroblast hyperproliferation and prevent bladder contractile dysfunction through effects on 5-alpha-reductase, a major enzyme shown to play a role in prostate growth (Cristoni et al. 2000, Levin and Das 2000). As such, pygeum may decrease excessive prostate growth (hyperplasia) and could allow for better contraction of the bladder for more productive urination. Both of these actions could improve the quality of life of men with BPH. The chemical composition of pygeum bark extracts are known to be rich in phytosterols such as beta-sitosterol, beta sitosterone, and campesterol, as well as ferulic acid esters including n-docosanol, and triterpenes including oleanolic acid, crataegolic acid and ursolic acid.
Animal studies indicate that partial bladder obstruction may lead to bladder contractile problems – with BPH-like symptoms prevented by pre-treatment with pygeum extract. In humans, several clinical trials have demonstrated the benefits of pygeum extract in alleviating symptoms of BPH (Breza et al. 1998, Chatelain et al. 1999, Ishani et al. 2000, Krzeski et al. 1993, Wilt et al. 2000, Wilt et al. 2002). In general, daily doses of pygeum bark extract at 25-100mg have demonstrated significant reductions in measures of the International Prostate Symptom Score (IPSS) of about 40% and increased quality of life (QOL) of about 30% (Breza et al. 1998). In one study, 209 patients with symptomatic BPH consumed 50mg or 100mg of pygeum extract for 2 months – with result showing similar effects in both dosage groups including 35% improvement in IPSS and 28% improvement in QOL (Chatelain et al. 1999). Other studies 18 controlled trials involving 1,562 men) have shown pygeum supplementation to decrease the frequency of nocturnal urination by 19%-32%, reduce residual urine volume by 24%, increase peak urine flow by 23%, and reduce nocturnal frequency by 32% (Breza et al. 1998, Ishani et al. 2000, Krzeski et al. 1993, Wilt et al. 2000).
The ferulic acid component of pygeum bark extracts has been noted to possess some modest anti-androgenic activity – leading bodybuilding enthusiasts to supplement with pygeum as a way to reduce conversion of testosterone to dihydrotestosterone (DHT) and thus enhance muscle cell exposure to free tesosterone. Such an effect has not been demonstrated in human trials. Likewise, the phytosterol component of pygeum bark extracts appear to compete with androgen precursors and in turn may be able to inhibit prostaglandin synthesis and provide a modest anti-inflammatory action (along with the triterpene components).
Side effects for those taking pygeum are relatively rare and mild, and are generally gastrointestinal in nature. No drug interactions have been reported. It is important for any man with an enlarged prostate to consult with his personal physician to determine the cause of prostate enlargement and to rule out prostate cancer.
Pygeum africanum bark extract is generally taken twice per day in 50mg capsules, although taking 100mg in a single dose has been shown to be just as effective and safe. The extract consists of three groups of active constituents: phytosterols, pentacyclic triterpenoids, and ferulic esters of long-chained fatty alcohols. Thus, this oily extract is typically sold in softgel capsule form that are standardized 14% triterpenes and 0.5% n-docosanol.
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EDITOR'S NOTE: This monograph can be found in The Health Professional's Guide to Dietary Supplements (Lippincott, Williams & Wilkins) by Shawn M. Talbott, PhD and Kerry Hughes, MS